The management of post-transplantation recurrence of hepatocellular carcinoma

Luckshi Rajendran, Tommy Ivanics, Marco PAW Claasen, Hala Muaddi, Gonzalo Sapisochin*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

28 Citations (Scopus)
25 Downloads (Pure)


The annual incidence of hepatocellular carcinoma (HCC) continues to rise. Over the last two decades, liver transplantation (LT) has become the preferable treatment of HCC, when feasible and strict selection criteria are met. With the rise in HCC-related LT, compounded by downstaging techniques and expansion of transplant selection criteria, a parallel increase in number of post-transplantation HCC recurrence is expected. Additionally, in the context of an immunosup-pressed transplant host, recurrences may behave aggressively and more challenging to manage, resulting in poor prog-nosis. Despite this, no consensus or best practice guidelines for post-transplantation cancer surveillance and recurrence management for HCC currently exist. Studies with adequate population sizes and high-level evidence are lacking, and the role of systemic and locoregional therapies for graft and extrahepatic recurrences remains under debate. This review seeks to summarize the existing literature on post-transplant HCC surveillance and recurrence management. It highlights the value of early tumour detection, re-evaluating the immunosuppression regimen, and staging to differentiate disseminated recurrence from intrahepatic or extrahepatic oligo-recurrence. This ultimately guides decision-making and maximizes treatment effect. Treatment recommendations specific to recurrence type are provided based on currently available locoregional and systemic therapies. (Clin Mol Hepatol 2022;28:1-16).

Original languageEnglish
Pages (from-to)1-16
Number of pages16
JournalClinical and Molecular Hepatology
Issue number1
Early online date5 Oct 2021
Publication statusPublished - Jan 2022

Bibliographical note

Publisher Copyright:
© 2022 by Korean Association for the Study of the Liver.


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